Osteogenic Differentiation of Human Mesenchymal Stem Cells Modulated by Surface Manganese Chemistry in SLA Titanium Implants

The manganese (Mn) ion has recently been probed as a potential candidate element for the surface chemistry modification of titanium (Ti) implants in order to develop a more osteogenic surface with the expectation of taking advantage of its strong binding affinity to the integrins on bone-forming cells. However, the exact mechanism of how Mn enhances osteogenesis when introduced into the surface of Ti implants is not clearly understood. This study investigated the corrosion resistance and potential osteogenic capacity of a Mn-incorporated Ti surface as determined by electrochemical measurement and examining the behaviors of human mesenchymal stem cells (MSCs) in a clinically available sandblasted/acid-etched (SLA) oral implant surface intended for future biomedical applications. The surface that resulted from wet chemical treatment exhibited the formation of a Mn-containing nanostructured TiO2 anatase thin film in the SLA implant and improved corrosion resistance. The Mn-incorporated SLA surface displayed sustained Mn ion release and enhanced osteogenesis-related MSC function, which enhanced early cellular events such as spreading, focal adhesion, and mRNA expression of critical adhesion-related genes and promoted full human MSC differentiation into mature osteoblasts. Our findings indicate that surface Mn modification by wet chemical treatment is an effective approach to produce a Ti implant surface with increased osteogenic capacity through the promotion of the osteogenic differentiation of MSCs. The improved corrosion resistance of the resultant surface is yet another important benefit of being able to provide favorable osseointegration interface stability with an increased barrier effect.

Implantoplasty Improves Clinical Parameters over a 2-Year Follow-Up: A Case Series

Background and Objectives: Peri-implantitis treatment is still undefined. Regenerative treatment is expensive and technically demanding due to the need to handle biomaterials, membranes and different methodologies of decontamination. Resective treatment and implantoplasty might be a viable solution. This case series presents a 24 month retrospective observational study of 10 peri-implantitis patients treated with implantoplasty. Materials and Methods: In the present case series, 10 peri-implantitis patients (20 implants) were treated with a resective approach and implantoplasty. Previous to implantoplasty, all patients underwent non-surgical treatment. This surgery consisted in a full-thickness flap and implant surface exposure. The exposed non-osseointegrated implant body was submitted to implantoplasty. The flap was apically repositioned and sutured. Patients were accompanied for 24 months. Results: The mean initial probing depth (PD) (PD = 5.37 ± 0.86 mm), bleeding on probing (BoP = 0.12 ± 0.06%) and suppuration (Sup = 0.01 ± 0.01%) decreased significantly at the 12 month evaluation (PD = 2.90 ± 0.39 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Between the 12 and 24 month evaluations, there were no significant clinical changes (PD = 2.85 ± 0.45 mm; BoP = 0.01 ± 0.01% and Sup = 0.00 ± 0.00%). Mucosal recession (MR) had a significant increase between the baseline and the first 12 months (0.69 ± 0.99 mm vs. 1.96 ± 1.33 mm), but there were no significant changes between the 12th and 24th month (1.94 ± 1.48 mm). The success rate was 100% without implant fracture or loss. Conclusions: Resective surgery and implantoplasty might be a valid option in some specific peri-implantitis cases. Properly designed clinical trials are needed to confirm this possibility.

Peri-implant tissue conditions following transcrestal and lateral sinus floor elevation: 3-year results of a bi-center, randomized trial

Objectives The present study was performed to comparatively evaluate the peri-implant bone stability and conditions of marginal tissues at 3 years following transcrestal and lateral sinus floor elevation (tSFE and lSFE, respectively). Materials and methods Patients included in a parallel-arm randomized trial comparatively evaluating tSFE and lSFE were recalled at 3 years post-surgery. Twenty-one and 24 patients in tSFE and lSFE groups, respectively, participated in the follow-up visit. Peri-implant bone support was evaluated as the proportion of the entire implant surface in direct contact with the radiopaque area (totCON%) on 3-year periapical radiographs. The conditions of the marginal peri-implant tissues at 3-year visit were classified as peri-implant health, peri-implant mucositis, or peri-implantitis. Results At 3 years, both groups showed an implant survival rate of 100%. Median totCON% was stable at 3 years, being 100% in both groups (p = 0.124). Peri-implant health and mucositis were diagnosed in 10 (47.6%) and 11 (52.4%) patients, respectively, in the tSFE group, and in 8 (33.3%) and 16 (66.7%) subjects, respectively, in the lSFE group (p = 0.502). Conclusions At 3 years following surgery, implants placed concomitantly with tSFE and lSFE fully maintain peri-implant bone support. Peri-implant mucositis was the most prevalent condition, with a similar prevalence between groups. Clinical relevance. Based on 3-year data on peri-implant bone support and prevalence of peri-implant diseases, the study suggests that tSFE and lSFE represent two equally valid options for the rehabilitation of the posterior maxilla. ClinicalTrials.gov ID: NCT02415946.

In vitro response of THP-1 derived macrophages to antimicrobially effective PHMB-coated Ti6Al4V alloy implant material with and without contamination with S. epidermidis and P. aeruginosa

Aim Periprosthetic joint infections are a devastating complication after arthroplasty, leading to rejection of the prosthesis. The prevention of septic loosening may be possible by an antimicrobial coating of the implant surface. Poly (hexamethylene) biguanide hydrochloride [PHMB] seems to be a suitable antiseptic agent for this purpose since previous studies revealed a low cytotoxicity and a long-lasting microbicidal effect of Ti6Al4V alloy coated with PHMB. To preclude an excessive activation of the immune system, possible inflammatory effects on macrophages upon contact with PHMB-coated surfaces alone and after killing of S. epidermidis and P. aeruginosa are analyzed. Methods THP-1 monocytes were differentiated to M0 macrophages by phorbol 12-myristate 13-acetate and seeded onto Ti6Al4V surfaces coated with various amounts of PHMB. Next to microscopic immunofluorescence analysis of labeled macrophages after adhesion on the coated surface, measurement of intracellular reactive oxygen species and analysis of cytokine secretion at different time points without and with previous bacterial contamination were conducted. Results No influence on morphology of macrophages and only slight increases in iROS generation were detected. The cytokine secretion pattern depends on the surface treatment procedure and the amount of adsorbed PHMB. The PHMB coating resulted in a high reduction of viable bacteria, resulting in no significant differences in cytokine secretion as reaction to coated surfaces with and without bacterial burden. Conclusion Ti6Al4V specimens after alkaline treatment followed by coating with 5–7 μg PHMB and specimens treated with H2O2 before PHMB-coating (4 μg) had the smallest influence on the macrophage phienotype and thus are considered as the surface with the best cytocompatibility to macrophages tested in the present study.

Current Progress in Breast Implant-Associated Anaplastic Large Cell Lymphoma

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon type of T-cell lymphoma. Although with a low incidence, the epidemiological data raised the biosafety and health concerns of breast reconstruction and breast augmentation for BIA-ALCL. Emerging evidence confirms that genetic features, bacterial contamination, chronic inflammation, and textured breast implant are the relevant factors leading to the development of BIA-ALCL. Almost all reported cases with a medical history involve breast implants with a textured surface, which reflects the role of implant surface characteristics in BIA-ALCL. With this review, we expect to highlight the most significant features on etiology, pathogenesis, diagnosis, and therapy of BIA-ALCL, as well as we review the physical characteristics of breast implants and their potential pathogenic effect and hopefully provide a foundation for optimal choice of type of implant with minimal morbidity.

Efficiency of cold atmospheric plasma, cleaning powders and their combination for biofilm removal on two different titanium implant surfaces

Objectives Biofilm removal is the decisive factor for the control of peri-implantitis. Cold atmospheric pressure plasma (CAP) can become an effective aid due to its ability to destroy and to inactivate bacterial biofilm residues. This study evaluated the cleaning efficiency of CAP, and air-polishing with glycine (APG) or erythritol (APE) containing powders alone or in combination with CAP (APG + CAP, APE + CAP) on sandblasted/acid etched, and anodised titanium implant surface. Materials and methods On respective titanium discs, a 7-day ex vivo human biofilm was grown. Afterwards, the samples were treated with CAP, APG, APE, APG + CAP, and APE + CAP. Sterile and untreated biofilm discs were used for verification. Directly after treatment and after 5 days of incubation in medium at 37 °C, samples were prepared for examination by fluorescence microscopy. The relative biofilm fluorescence was measured for quantitative analyses. Results Air-polishing with or without CAP removed biofilms effectively. The combination of air-polishing with CAP showed the best cleaning results compared to single treatments, even on day 5. Immediately after treatment, APE + CAP showed insignificant higher cleansing efficiency than APG + CAP. Conclusions CAP supports mechanical cleansing and disinfection to remove and inactivate microbial biofilm on implant surfaces significantly. Here, the type of the powder was not important. The highest cleansing results were obtained on sandblasted/etched surfaces. Clinical relevance. Microbial residuals impede wound healing and re-osseointegration after peri-implantitis treatment. Air-polishing treatment removes biofilms very effectively, but not completely. In combination with CAP, microbial free surfaces can be achieved. The tested treatment regime offers an advantage during treatment of peri-implantitis.

Recent progress in Tannic Acid-driven antimicrobial/antifouling surface coating strategies

Medical devices and surgical implants are a necessary part of tissue engineering and regenerative medicines. However, the biofouling and microbial colonization on the implant surface continues to be a major...

Coronary artery aneurism: a clinical case

INTRODUCTION: Coronary artery aneurysm is a local dilatation of vessel 1.5–2-fold the initial diameter. In more than 40%, an aneurism is located in the right coronary artery, the next most common locations are the anterior interventricular artery and circumflex artery. An aneurism of the left coronary artery is a very rare finding seen in approximately 0.1% of patients. It is believed that in more than 50% of cases, coronary artery aneurisms develop with the underlying atherosclerosis, in 20–30% of cases they are hereditary, and in 10–20% of cases they are described in association with inflammatory diseases. Although thrombosis inside the cavity of aneurism may lead to distal embolization and development of myocardial infarction even in the absence of atherosclerosis of coronary arteries, its existence is not in all cases the indication for surgical treatment and in most cases decision on surgical approach is dictated by the severity of the coronary artery disease. In the given work, a clinical case of a patient with an aneurism of the left coronary artery is presented that developed after stenting with a bare metal stent. In our opinion, factors that influenced formation of aneurism in this clinical case were a dynamic impact of the blood flow on the damaged wall of the left main coronary artery through the holes in the stent, absence of endothelization of the implant surface in result of interaction of different biochemical and molecular-genetic mechanisms. CONCLUSION: Coronary artery aneurisms are not sufficiently studied and require investigations in the following directions: etiology and pathogenesis; optimal surgical treatment methods; place of conservative therapy in asymptomatic patients.

Preservação em próteses implantossuportadas: peri-implantite / reservation in implant-supported prostheses: Peri-implantitis

Resumo: A identificação e o tratamento da infecção ao redor do implante é uma etapa essencial na manutenção do implante osseointegrativo e isso reflete na vida útil da reabilitação. O principal objetivo do tratamento da peri-implantite é a utilização de métodos de descontaminação mecânica e química para eliminar a carga bacteriana na superfície do implante. O biofilme pode ser removido por métodos não cirúrgicos ou cirúrgicos. Nos casos mais graves, geralmente é necessário tratamento cirúrgico, cujo objetivo é corrigir o defeito ósseo existente, combinado com a aplicação do enxerto, para regenerar o tecido ósseo perdido no processo inflamatório. O propósito deste estudo é realizar uma revisão de literatura tendo como o tema preservação em próteses implantossuportadas: peri-implantite, a fim de guiar a conservação das reabilitações orais. Além de buscar maiores informações acerca do desenvolvimento da doença peri-implantar, bem como sua ligação com a doença periodontal e os fatores que contribuem para seu desenvolvimento. Para tanto, foram utilizados descritores como: “peri-implantite", "manutenção de implantes" e “ossointegração” nas bases de dados: Pubmed, Scielo, google acadêmico e Lilacs. Para possibilitar um melhor resultado, foram organizados tópicos para uma discussão final, sendo eles: conceito, etiologia, diagnóstico e tratamento. Foram encontradas dificuldades na manutenção dos implantes e a necessidade de se descrever o melhor planejamento para uma melhoria nos protocolos clínicos de preservação a fim de obter-se excelência nos desfechos clínicos.Abstract: The identification and treatment of infection around the implant is an essential step in the maintenance of the osseointegrative implant and this reflects on the lifetime of the rehabilitation. The main objective of peri-implantitis treatment is the use of mechanical and chemical decontamination methods to eliminate the bacterial load on the implant surface. Biofilm can be removed by non-surgical or surgical methods. In more severe cases, surgical treatment is usually necessary, the aim of which is to correct the existing bone defect, combined with the application of a graft, to regenerate the bone tissue lost in the inflammatory process. The purpose of this study is to conduct a literature review with the theme of preservation in implant-supported prostheses: peri-implantitis, in order to guide the conservation of oral rehabilitations. In addition to seeking more information about the development of peri-implant disease, as well as its connection with periodontal disease and the factors that contribute to its development. For this purpose, descriptors such as: “peri-implantitis”, “implant maintenance” and “bone integration” were used in the following databases: Pubmed, Scielo, academic Google and Lilacs. final discussion, namely: concept, etiology, diagnosis, and treatment. Difficulties were found in the maintenance of implants and the need to describe the best planning for an improvement in clinical preservation protocols in order to obtain excellence in clinical outcomes. Plaque control maintains the health of the soft tissue-implant interface.Keywords: Dental implants; Peri-implantitis; Bacterial plaque.